Chevron osteotomy tools and methods

ABSTRACT

A targeting guide is disclosed includes a handle extending substantially along a longitudinal axis. The longitudinal handle defines one or more burr holes extending from a first side of the handle to a second side of the handle. A head is coupled to a distal end of the longitudinal handle. The head defines a plurality of guide holes sized and configured to receive a k-wire therethrough.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.15/756,446, filed Feb. 28, 2018, which is a national phase entry under35 U.S.C. § 371 of international patent application no.PCT/US2016/049981, filed Sep. 1, 2016 which claims benefit under 35U.S.C. § 119(e) to U.S. Provisional Application No. 62/213,161, filedSep. 2, 2015, and entitled “CHEVRON OSTEOTOMY TOOLS AND METHODS,” theentirety entireties of which is are incorporated herein by reference.

BACKGROUND

Current procedures to perform a chevron osteotomy include the use of anosteotome/periosteal elevator. The use of the osteotome elevator is lessthan ideal, as the length, contours, tip, and sharpness, and overallergonomics of the osteotome elevator are not configured for chevronosteotomy and may result in damage to soft tissue and/or bone. Theosteotome elevator is typically round and prone to rotation during use,making the osteotome elevator difficult to operate with a single hand,as is common during chevron procedures.

Current procedures for a chevron osteotomy further fail to provide idealfixation of one or more permanent fixation members. Displacement of boneportions during the osteotomy procedure, such as through the use of anelevator, can make fastener placement difficult.

BRIEF DESCRIPTION OF THE FIGURES

The features and advantages of the present invention will be more fullydisclosed in, or rendered obvious by the following detailed descriptionof the preferred embodiments, which are to be considered together withthe accompanying drawings wherein like numbers refer to like parts andfurther wherein:

FIGS. 1A-1G illustrate one embodiment of a targeting guide for use in asurgical procedure, such as a chevron osteotomy, in accordance with thepresent disclosure

FIG. 2 illustrates one embodiment of a targeting guide including a headhaving three tongs, in accordance with the present disclosure.

FIG. 3 illustrates one embodiment of a targeting guide having a flathead, in accordance with the present disclosure.

FIG. 4 illustrates one embodiment of a targeting guide having arotatable head portion, in accordance with the present disclosure.

FIGS. 5A-5C illustrate one embodiment of an displacement elevator, inaccordance with the present disclosure.

FIG. 6 illustrates one embodiment of an displacement elevator having asolid neck portion, in accordance with the present disclosure.

FIG. 7 illustrates one embodiment of a displacement elevator having anopen end and an open neck between a first cavity and a second cavity, inaccordance with the present disclosure.

FIG. 8 illustrates one embodiment of a displacement elevator having anopen end, in accordance with the present disclosure.

FIG. 9 illustrates one embodiment of a displacement elevator having anopen end and a solid neck, in accordance with the present disclosure.

FIG. 10 illustrates one embodiment of a displacement elevator includinga securing section for securing a portion of a toe, in accordance withthe present disclosure.

FIG. 11 illustrates one embodiment of a displacement elevator includinga securing section and a gripping handle, in accordance with the presentdisclosure.

FIG. 12A illustrates one embodiment of a surgical screw placement guide,in accordance with the present disclosure.

FIG. 12B is a top view of the surgical screw placement guide of FIG.12A, in accordance with the present disclosure.

FIG. 12C is a radiographic view of the surgical screw placement guide ofFIG. 12A adjacent to a bone, in accordance with the present disclosure.

FIG. 13A illustrates one embodiment of a surgical screw placement guide,in accordance with the present disclosure.

FIG. 13B illustrates the surgical screw placement guide of FIG. 13A incontact with one or more bones, in accordance with the presentdisclosure.

FIG. 13C illustrates a radiographic view of the surgical screw placementguide of FIG. 13A adjacent to one or more bones, in accordance with thepresent disclosure.

FIG. 14 illustrates one embodiment of a method of performing a chevronosteotomy, in accordance with the present disclosure.

FIGS. 15A-15G illustrates various steps of the method of FIG. 14 , inaccordance with the present disclosure.

FIGS. 16A-16B illustrate one embodiment of a step of displacing ametatarsal during the method of FIG. 14 , in accordance with the presentdisclosure.

FIGS. 17A-17D illustrate one embodiment a step of inserting one or morek-wires into a metatarsus using a targeting guide during the method ofFIG. 14 , in accordance with the present disclosure.

DETAILED DESCRIPTION

This description of the exemplary embodiments is intended to be read inconnection with the accompanying drawings, which are to be consideredpart of the entire written description. In the description, relativeterms such as “lower,” “upper,” “horizontal,” “vertical,”, “above,”“below,” “up,” “down,” “top” and “bottom” as well as derivative thereof(e.g., “horizontally,” “downwardly,” “upwardly,” etc.) should beconstrued to refer to the orientation as then described or as shown inthe drawing under discussion. These relative terms are for convenienceof description and do not require that the apparatus be constructed oroperated in a particular orientation. Terms concerning attachments,coupling and the like, such as “connected,” refer to a relationshipwherein structures are secured or attached to one another eitherdirectly or indirectly through intervening structures, as well as bothmovable or rigid attachments or relationships, unless expresslydescribed otherwise.

In various embodiments, a displacement tool for use in an osteotomyprocedure is disclosed. The displacement tool includes a body having ahandle portion and a displacement portion. The displacement portionextends longitudinally from a first end of the handle portion. Thedisplacement portion has a predetermined curve. In some embodiments, thedisplacement portion has a rounded distal tip. In other embodiments, thedisplacement portion has a pointed distal tip. The displacement tool issized and configured to displace a portion of a toe during an osteotomywithout causing damage to soft tissue or bones of the toe.

In some embodiments, a surgical targeting guide for use in an osteotomyprocedure is disclosed. The surgical targeting guide includes a bodyhaving handle and a head coupled to a distal end of the body. The handleextends substantially along a longitudinal axis. The handle defines aplurality of guide holes each sized and configured to receive a firstelongate surgical instrument, such as a burr, therethrough. The headdefines a plurality of targeting holes each sized and configured toreceive a second elongate surgical instrument, such as a k-wire,therethrough. In some embodiments, the targeting holes extend throughthe head at a predetermined angle with respect to a longitudinal axis ofthe handle.

In some embodiments, a surgical screw guide for use in an osteotomyprocedure is disclosed. The surgical screw guide includes a bodyincluding central section extending from a first end to a second end anddefining a first slot between the first end and the second end and afirst arm extending from the first end of the central section anddefining a first hole. An alignment body is slidably received within thefirst slot defined by the central section of the body. A lockingmechanism is coupled to a first end of the alignment body. The lockingmechanism is configured to lock the alignment body at a location along alength of the first slot defined by the central section of the body.

FIGS. 1A-1G illustrate one embodiment of a surgical targeting guide 2for use in a surgical procedure, such as, for example, a chevronosteotomy. The targeting guide 2 includes a body 4 having a handle 6 anda head 8. The handle 6 extends substantially along a longitudinal axisfrom a proximal end to a distal end. The handle 6 defines a plurality ofpositioning holes 10 each sized and configured to receive a firstelongate surgical instrument, such as, for example, a burr,therethrough. The first elongate surgical instrument is coupled to ananatomical structure, such as a bone, and positions the surgicaltargeting guide 2 with respect to the anatomical structure.

In some embodiments, the plurality of positioning holes 10 are arrangedsubstantially over a proximal half of the handle 6. The positioningholes 10 can extend through the handle 6 along an axis perpendicular tothe longitudinal axis of the handle 6 and/or at an angle with respect tothe longitudinal axis. For example, in some embodiments, the positioningholes 10 can extend through the handle 6 at any angle substantiallybetween 0-90° with respect to the longitudinal axis of the handle 6.

In some embodiments, a head 8 is coupled to and/or formed integrallywith a distal end of the handle 6. The head 8 can be coupled to thehandle 6 at a predetermined angle, such as for example, any anglebetween 0-90°, such as 10°, 15°, 30°, 45°, 60°, 75°, 80°, 90°, and/orany other suitable angle. The head 8 defines a plurality of guide holes12 extending therethrough. The plurality of guide holes 12 are eachsized and configured to receive a second elongate surgical instrument,such as a k-wire, therethrough. The guide holes 12 extend from a firstside to a second side of the head 8. For example, in some embodiments,one or more guide holes 12 extend from a proximal face/side of the head8 to a distal side/face. In some embodiments, a first set of guide holes10 can extend from a first face to a second face and a second set ofguide holes 10 can extend from the first face to one or more additionalfaces of the head 8.

In some embodiments, the distal surface of the head 8 includes astepped-configuration including a plurality of step levels 14 a-14 c.The plurality of step levels 14 a-14 c provide different positionsand/or angles of insertion with respect to a k-wire 125 inserted througha guide hole 12. Each of the plurality of levels 14 a-14 c includes aplurality of guide holes 12 extending from proximal side 16 of the head8 to a distal side 18. In some embodiments, the plurality of guide holes12 through of the plurality of levels 14 a-14 c extend through the head8 at a different angle, as illustrated in FIG. 1E. The plurality ofguide holes 12 and step-levels 14 a-14 c allow a surgeon to select thebest location for insertion of k-wires or other elongate surgicalinstruments during surgery.

In some embodiments, the head 8 includes a cutout 20 sized andconfigured to interface with a portion of an anatomical structure, suchas, for example, one or more bones of the foot. The cutout 20 and theedges of the head 8 define one or more tines 20 a, 20 b. The cutout 20is sized and configured to allow the tines 20 a, 20 b to be positionedon opposite sides of the anatomical structure. For example, in someembodiments, the cutout 20 is sized and configured to receive ametatarsal and/or one or more additional toe bones therein to positionthe tines 20 a, 20 b on opposite sides of the metatarsal.

In some embodiments, the body 4 of the targeting guide 2 is configuredto guide one or more k-wires during a surgical chevron osteotomy. Thetargeting guide 2 is placed exterior of a foot at a surgical site. Insome embodiments, at least one of the positioning holes 10 is placedover a first elongate surgical instrument, such as a burr, coupled tothe anatomical structure to position the targeting guide 2. The firstelongate surgical instrument can be coupled to the anatomical structureprior to and/or simultaneous with positioning of the targeting guide 2.After the targeting guide 2 is positioned at a surgical site, one ormore k-wires are inserted through the k-wire holes 12 formed in the head8 and anchored to one or more bones. The targeting guide 2 can beremoved from the surgical site by sliding the targeting guide 2 over thek-wires and burr. In some embodiments, the handle 6 includes a pluralityof gripping features 24 sized and configured to allow a user to securelygrip the targeting guide 2 during a surgical procedure.4

FIGS. 2-4 illustrate alternative embodiments of the targeting guide 2,in accordance with the present disclosure. FIGS. 2 and 3 illustrateembodiments of a targeting guide 102 including a head 108 having threetongs 120 a-120 c. The targeting guide 102 a illustrated in FIG. 2 issimilar to the targeting guide 2. The head 108 of the targeting guide102 a has three tines 120 a-120 c extending from a common base 122. Insome embodiments, an additional anchoring section 124 extends from acentral tine 120 b of the head 108. A plurality of k-wire holes 112extend from a first side of the head 108 (shown) to a second side of thehead 108 (not shown).

The targeting guide 102 b illustrated in FIG. 3 includes a flat headhaving a plurality of k-wire holes therethrough. In some embodiments,the plurality of guide holes 112 extend through the flat head 108 at apredetermined angle. For example, in various embodiments, the pluralityof guide holes 112 can extend through the flat head 108 at any anglesubstantially between 0-90°, such as 15°, 30°, 45°, 60°, 75°, 90°,and/or any other suitable angle. In the illustrated embodiment, each ofthe sections 120 a-120 c includes four guide holes 112, although it willbe appreciated that each of the sections 120 a-120 c of the head 108 caninclude any suitable number of guide holes 112.

FIG. 4 illustrates one embodiment of a targeting guide 202 having arotatable head 208, in accordance with the present disclosure. Thetargeting guide 202 includes a body 204 having a handle 206 rotatablycoupled to a head (or targeting portion) 208. The body 204 includes atleast one positioning hole 210 sized and configured to receive a firstelongate surgical instrument, such as a guide pin 225 or a burr,therein. In some embodiments, the body 204 includes a plurality ofgripping features 224. The body 204 is rotatably coupled to the head 208by a rotatable joint 230. The rotatable joint 230 may comprise a pin 232inserted one or more pin slots 234 a, 234 b, 236 formed in the handle206 and/or the head 208. The head 208 rotates about the rotatable joint230 to position the targeting guide 208 with respect to a portion ofpatient's anatomy. The head 208 includes a plurality of guide holes 212each sized and configured to receive a second elongate surgicalinstrument, such as a k-wire, therethrough.

FIGS. 5A-5C illustrate an embodiment of a surgical elevator 302, inaccordance with the present disclosure. The elevator 302 includes a body304 having a displacement tip 306 extending therefrom. The displacementtip 306 defines a predetermined radius of curvature 318. In someembodiments, the body 304 includes a distal portion 308 and a proximalportion 312 configured to allow flexing of the elevator 302 between thedistal portion 308 and the proximal portion 312. The body 304 defines aninner cavity 310. In some embodiments, the inner cavity 310 is sized andconfigured to receive one or more anatomical features of a patienttherein, such as, for example, one or more bones. The inner cavity 310allows the elevator 302 to be positioned and/or flexed beyond the planeof a patient's foot.

In some embodiments, the elevator 302 is configured to generate and/orfacilitate generation of an osteotomy in a bone, such as a metatarsal.The displacement tip 306 is sized and configured to be inserted into acut formed in a bone. The body 304 is rotated in a first direction toforce a first bone portion away from a second bone portion to form anosteotomy. In some embodiments, the inner cavity 310 defines a firstcavity portion 314 and a second cavity portion 316 designed to receiveone or more anatomical structures, such as a bone portion, when the body304 is rotated. In some embodiments, the first and/or second cavityportions 314, 316 are sized and configured to receive a portion of ametatarsal therein.

FIGS. 6-11 illustrate various alternative embodiments of a surgicalelevator 402. The surgical elevator 402 is similar to the surgicalelevator 302 discussed above, and similar description is not repeatedherein. FIG. 6 illustrates one embodiment of an elevator 402 a having afirst inner cavity 414 and a second inner cavity 416 separated by aclosed neck 420 of the body 404. The elevator 402 includes a body 404and a displacement tip 406 extending therefrom. A distal end 422 of thedisplacement tip 406 is sized and configured to be received within a cutformed in a bone, such as, for example, a metatarsus. FIG. 7 illustratesone embodiment of an elevator 402 b similar to the elevator 302, andsimilar description is not repeated herein. The elevator 402 b has asmaller neck opening 418 as compared to the elevator 302 of FIGS. 5A-5C.The smaller neck opening 424 provides a different flex profile to thebody 404 of the elevator 402 b. In some embodiments, the smaller neckopening 424 increases flex at the neck 420.

FIG. 8 illustrates one embodiment of an elevator 402 c having an openproximal end 426. The open proximal end 426 allows a first side 428 a ofthe body 404 to flex independent of and/or out of plane of a second side428 b of the body 404. FIG. 9 illustrates one embodiment of an elevator402 d having an open proximal end 426 and a closed neck 420. Thedifferent open/closed necks and/or open/closed ends of the variouselevators 402 illustrated in FIGS. 6-9 provide different flex and forceprofiles. In some embodiments, the open proximal end 426 allows theelevator 402 c, 402 d to flex at a greater angle with respect to themetatarsal.

FIG. 10 illustrates one embodiment of a longitudinal elevator 502. Thelongitudinal elevator 502 includes a longitudinal body 504 extendingsubstantially along a longitudinal axis. A displacement tip 506 extendsfrom a distal end of the longitudinal body 504. The displacement tip 506is sized and configured for insertion into a cut formed in a bone, suchas, for example, a metatarsal. The longitudinal body 504 can be rotatedby a user to displace a first portion of a bone from a second portion ofa bone to form an osteotomy. In some embodiments, the longitudinal body504 defines a bone retaining section 508. The bone retaining section 508can comprise a concave and/or open area for securing a portion of abone, such as a distal portion of a metatarsal, after displacement ofthe bone portion to form an osteotomy. For example, in the illustratedembodiment, the longitudinal body 504 defines a concave retainingsection 508 sized and configured to secure a distal portion of ametatarsal bone after the displacement tip 506 displaces a first portionof the metatarsal from a second portion of the metatarsal to form anosteotomy. In some embodiments, as shown in FIG. 11 , the longitudinalhandle 504 is surrounded by a large, gripping handle 510 to provideadditional gripping surface to a user.

FIGS. 12A-12C illustrates one embodiment of a surgical screw guide 600 aconfigured to provide positioning of one or more fasteners, inaccordance with the present disclosure. The surgical guide 600 aincludes a body 602. The body 602 defines a central section 603extending from a first end 604 to a second end 606. The central section603 defines a first slot 622 between the first end 604 and the secondend 606. The body 602 includes a first arm 608 extending from the firstend 604 of the central section 603 and defining a first hole 610. Thefirst hole 610 is sized and configured to receive a guide wire 125therethrough. In some embodiments, the first arm 608 extendsperpendicularly from the central section, although it will beappreciated that the first arm can extend at any suitable angle, such asany angle between 0-90°.

In some embodiments, an alignment body 612 is slidably received withinthe first slot 622 defined by the central section 603 of the body 602.The alignment body 612 is configured to move along the length of thefirst slot 622 and can be configured to move transversely relative to alongitudinal axis defined by the first slot 622. A locking mechanism 616is coupled to a first end of the alignment body 612. The lockingmechanism 616 is configured to lock the alignment body 612 at a variablelocation along a length of the first slot 622. The locking mechanism 616can include any suitable locking mechanism, such as, for example, athumb screw, a wing nut, and/or any other suitable locking mechanism.

In some embodiments, the alignment body 612 defines a second slot 614that inwardly extends from a second end of the alignment body 612. Thefirst hole 610 and the second slot 614 are configured to receive anelongate surgical instrument, such as guide wire 125, therein. In someembodiments, the first hole 610 and the second slot 614 are alignedalong a longitudinal axis. In some embodiments, the elongate surgicalinstrument has a radius of curvature and/or can selectively be bent. Thefirst hole 610 and the second slot 614 can be positioned to receive anelongate surgical instrument having a predetermined radius of curvature.

In some embodiments, the body 602 includes a second arm 620 extendingfrom the second end 606 of the central section.603. In some embodiments,the second arm 620 defines one or more holes 626 a, 626 b extending froma first side of the body 602 to a second side. The first and secondholes 626 a, 626 b each extend through the second arm 620 along alongitudinal axis. In some embodiments, the longitudinal axes of thefirst and second holes 626 are parallel. In some embodiments, thelongitudinal axes of the first and second holes 626 a, 626 b extend at apredetermined angle, such as, any angle between 0-90°.

FIGS. 13A-13C illustrate another embodiment of a surgical guide 600 b,in accordance with the present disclosure. The surgical guide 600 bincludes a body 650. The body 650 defines a central section 652extending from a first end 654 to a second end 658. The central section652 defines a first slot 656 a between the first end 654 and the secondend 658. The body 650 includes a first arm 660 extending from the firstend 654 of the central section 652 and defining a first hole 670. Thefirst hole 670 is sized and configured to receive a second elongatesurgical instrument, such as a k-wire, therethrough. In someembodiments, the first hole 670 extends through the first arm 660 in aplane that is perpendicular to a longitudinal direction of the centralsection 652.

In some embodiments, an alignment body 666 is slidably received withinthe first slot 656 a defined by the central section 652 of the body 650.The alignment body 666 is configured to slidably move within the firstslot 656 a and can be further configured to move transversely relativeto a longitudinal axis defined by the first slot 656 a. A lockingmechanism 668 is coupled to a first end of the alignment body 666. Thelocking mechanism 668 is configured to lock the alignment body 666 at avariable location within the first slot 656 a. The locking mechanism 668can include any suitable locking mechanism, such as, for example, athumb screw, a wing nut, and/or any other suitable locking mechanism.

In some embodiments, the body 650 defines a second slot 656 b. The firstslot 656 a can extend through a first side and a second side of a firstportion 652 a of the central section 652 and the second slot 656 b canextend through a third side and a fourth side of a second portion 652 bof the central section 652 of the body. In some embodiments, the firstslot 656 a and the second slot 656 b are parallel, although it will beappreciated that, in some embodiments, the first slot 656 a and thesecond slot 656 b can be offset. Each of the first slot 656 a and thesecond slot 656 b have a predetermined longitudinal length. In someembodiments, the longitudinal length of the first slot 656 a and thesecond slot 656 b is equal.

In some embodiments, the alignment body 666 includes a rotatable portion672 configured to rotate or pivot about an axis that is orientedperpendicularly with respect to a longitudinal direction of the centralsection 652. The rotatable portion 672 can be positioned between thefirst slot 656 a and the second slot 656 b. The alignment body 666 candefine one or more holes extending therethrough. For example, in someembodiments, the rotatable portion 672 includes a first hole 674 a thatextends through the rotatable portion 672 in a first direction and asecond hole 674 b that extends through the rotatable portion 672 in asecond direction. In various embodiments, the first direction can beperpendicular to the second direction and/or positioned at an anglesubstantially between 0-90° with respect to the second direction. Insome embodiments, the first hole 674 a and the second hole 674 b aresized and configured to receive fasteners 680 a, 680 b therethrough. Thefirst and second holes 674 a, 674 b guide the fasteners 680 a, 680 binto appropriate positions for fixing an osteotomy. In some embodiments,the alignment body 666 defines a third hole 676 extending through thealignment body 666 along a longitudinal axis that is perpendicular to aplane defined by the first hole 674 a and/or the second hole 674 b.

In some embodiments, the first arm 660 is configured to rotate about alongitudinal axis defined by the central section 652 of the body 650.The position of a longitudinal axis of the first hole 670 extendingthrough the first arm 660 can be adjusted by rotating the first arm 660about the longitudinal axis of the central section 652. In someembodiments, the first arm 660 is configured to slide in one or moredirections that are perpendicular to the longitudinal axis defined bythe central section 652. For example, in some embodiments, a centerpoint of the first arm 660 can be adjusted laterally with respect to thelongitudinal axis defined by the central section 652.

In some embodiments, one or more of the surgical targeting guides,surgical elevators, and/or surgical screw guides disclosed herein can beused to perform a surgical procedure, such as, for example, a chevronosteotomy. FIGS. 14-15G illustrate one embodiment of a chevron osteotomymethod 700, in accordance with some embodiments. At step 702, a cut isformed in a metatarsal at a surgical site 800. As shown in FIG. 15A, afoot 802 comprises a plurality of bones, including a first toe 804having a plurality of phalanges 806 a-806 b, a metatarsus 808, and aplurality of cuneiforms 810. A portion of the metatarsal 808 is removedduring the initial cut. In some embodiments, one or more continuousand/or non-continuous cuts are made to form a chevron—shaped osteotomy.For example, in some embodiments, rotation of the burr 812 about a pointof entry into the patient's anatomy is used to form a dorsal limb and aplantar limb of a chevron osteotomy. The plane of the osteotomy isdefined by the entry cut of the burr 812 into the metatarsal 808. Theburr 812 may be left in a final position to act as a guide for one ormore additional surgical elements.

At step 704, a portion of the metatarsal, such as the metatarsal head,is displaced from an initial position, as shown in FIG. 15B. In someembodiments, the displacement of the metatarsal head is achieved by adisplacement elevator 302 as shown and described herein. As shown inFIGS. 16A-16B, a displacement tip 306 of an elevator 302 can bepositioned near a metatarsal 808 to displace a portion of themetatarsal. The body 304 of the elevator 302 is rotated such that thedisplacement tip 306 displaces a first portion 810 from a second portionof the metatarsus 808 to form an osteotomy. In some embodiments, aportion of the body 304 is sized and configured to maintain a section ofthe metatarsus 808, 810 in a fixed position after formation of theosteotomy. In some embodiments, the body 304 includes one or morecavities 312, 314 sized and configured to receive a portion of thepatient's anatomy, such as, for example, one or more phalanges.

At step 706, one or more k-wires 125 are inserted into a portion of thepatient's anatomy, such as one or more phalanges 806 a, 806 b and/ormetatarsals 808. The k-wires 125 can be inserted through a targetingguide, such as the targeting guide 102 illustrated above. FIGS. 17A-17Cillustrate insertion of one or more k-wires through a target guide 102.A targeting guide 102 can placed against an outer surface of a patient'sfoot 850 near the metatarsus 808. The targeting guide 102 is slidablycoupled to a burr 812 previously inserted into the metatarsus 808. Insome embodiments, the burr 812 is inserted perpendicular to alongitudinal axis of the metatarsus 808.

The targeting guide 102 is inserted over the burr 812 to position aplurality of k-wire guide holes 112 next to the metatarsal 808. As shownin FIGS. 14B-14D, one or more k-wires are inserted into the patient, forexample, into the metatarsus 808 through the k-wire guide holes 112. Thek-wire guide holes 112 guide the k-wires 125 to a predeterminedimplantation position within the patient's toe. For example, in someembodiments, the k-wires 125 are implanted through the guide holes 112to one or more positions corresponding to a chevron osteotomy.

At step 708, after the k-wires 125 are implanted, the targeting guide102 can be removed from the surgical site 802. The k-wires 125 can beinserted from a dorsal (proximal fragment) to planter (head fragment),for example, utilizing a long tail/plantar limb of the chevron and/orcan be inserted from a dorsomedial (proximal fragment) to planterlateral (head fragment). In some embodiments, a k-wire 125 is insertedthrough one or more cortices of the proximal fragment prior to entryinto the metaphysis of the head fragment. In some embodiments, the burr812 is removed from the metatarsal and the targeting guide 102 isslidably removed over the k-wires 125. In some embodiments, a cut ismade in the metatarsus 808 to facilitate removal of the targeting guide102 and burr 812. The cut may be formed by, for example, the burr 812and/or any other suitable cutting instrument.

At step 710, the osteotomy is fixed using one or more fixation devices820. For example, in some embodiments, one or more screws may beinserted through a first portion 808 into a second portion 810 to fixthe osteotomy. In some embodiments, the fixation devices includecannulated screws inserted from the second portion 808 to a firstportion 810 of the metatarsus 808. In other embodiments, one or moreadditional percutaneous k-wires 125 are inserted to permanently fix theosteotomy.

In some embodiments, insertion of one or more fixation devices 820 isfacilitated by a surgical guide, such as the surgical guides 600 a, 600b described above. In some embodiments, the surgical guide 600 a, 600 bis coupled to a k-wire 125 previously inserted at a surgical site 800.The k-wire 125 can be coupled to the surgical guide 600 a, 600 b bysliding the k-wire 125 through one or more holes and/or slots defined bythe surgical guide 600 a, 600 b. For example, in some embodiments, thesurgical guide 600 a is positioned by sliding a k-wire 125 through afirst hole 610 defined by a first arm 608 and a slot 614 defined by analignment body 612.

One or more fasteners 680 a, 680 b can be inserted through one or morefastener holes 626 a, 626 b 674 a,674 b defined in a portion of thesurgical guide 600 a, 600 b. For example, in some embodiments, a firstfastener 680 a and a second fastener 680 b are inserted through firstand second fastener holes 626 a, 626 b formed in a second arm 620 of thesurgical guide 600 a. A first fastener 680 a can be inserted at an anglewith respect to a second fastener 680 b (as shown in FIG. 15F) and/orcan be inserted parallel to the second fastener 680 b (as shown in FIG.15G). The fasteners 680 a, 680 b maintain the osteotomy in a fixedposition during bone healing.

In various embodiments, a targeting guide is disclosed. The targetingguide includes a handle extending substantially along a longitudinalaxis. The longitudinal handle defines one or more burr holes extendingfrom a first side of the handle to a second side of the handle. A headis coupled to a distal end of the longitudinal handle. The head definesa plurality of guide holes sized and configured to receive a k-wiretherethrough.

In some embodiments, a distal surface of the head comprises a steppedsurface including a plurality of offset surfaces. Each of the pluralityof offset surfaces can define a distal opening of at least one of theplurality of guide holes.

In some embodiments, a first set of the plurality of guide holes extendsthrough the head at a first angle and a second set of the plurality ofguide holes extend through the head at a second angle. The one or moreburr holes can extend through a proximal portion of the handle.

In some embodiments, the head defines a cutout extending from the distalsurface towards the proximal surface of the head. The cutout is sizedand configured to receive a bone therein. The head can include a firsttine, a second tine, and a third tine. The first tine is separated fromthe second tine by a first channel and the second tine is separated fromthe third tine by a second channel. Each of the first, second, and thirdtine can define at least one of the plurality of guide holes. In someembodiments, a rectangular anchoring section extends from a distal endof the second tine.

In some embodiments, a rotatable joint couples the handle to the headsuch that the head is rotatable with respect to the handle.

In various embodiments, an elevator is disclosed. The elevator includesa body defining a first inner cavity sized and configured to receive atleast one bone therein and a displacement tip extending from a distalportion of the body. The displacement tip includes a predeterminedradius of curvature and is sized and configured to be inserted between afirst bone and a second bone. The body can include a closed neckdefining a flex point of the body. The body and the closed neck candefine the first inner cavity and a second inner cavity. In someembodiments, the body defines an open proximal end.

In various embodiments, a method of forming an osteotomy in a bone isdisclosed. The method includes inserting a burr at a surgical site andpositioning a targeting guide adjacent to an outer surface of a surgicalsite. The targeting guide comprises a handle extending substantiallyalong a longitudinal axis. The handle defines at least one burr holeextending from a first side of the handle to a second side of thehandle. The targeting guide is slidably coupled to the burr by insertingthe burr into the burr hole. One or more k-wires are inserted into atleast one bone at the surgical site. The one or more k-wires areinserted through a plurality of guide holes formed in a head of thetargeting guide. The targeting guide and the burr are removed from thesurgical site after inserting the k-wires.

In some embodiments, a bone at the surgical site is cut prior tocoupling the targeting guide to the burr. The cut separates the boneinto a first bone portion and a second bone portion.

In some embodiments, the method further includes inserting an elevatorbetween the first bone portion and the second bone portion at thesurgical site. The elevator comprises a body defining a first innercavity sized and configured to receive at least one bone therein and adisplacement tip extending from a distal portion of the body. Thedisplacement tip includes a predetermined radius of curvature and issized and configured to be inserted between the first bone portion andthe second bone portion. An osteotomy is formed between the first boneportion and the second bone portion using the elevator. The osteotomycan be a chevron osteotomy.

In some embodiments, the step of inserting one or more k-wires into theat least one bone includes inserting a first k-wire through a firstguide hole in the head and inserting a second k-wire through a secondguide hole in the head. The first guide hole is defined by a first tineextending from a base of the head and the second guide hole is definedby a second tine extending from the base of the head. In someembodiments, the bone comprises a metatarsal.

In some embodiments, a surgical guide is disclosed. The surgical guideincludes a body including central section extending from a first end toa second end and defining a first slot between the first end and thesecond end and a first arm extending from the first end of the centralsection and defining a first hole. An alignment body is slidablyreceived within the first slot defined by the central section of thebody. A locking mechanism is coupled to a first end of the alignmentbody. The locking mechanism is configured to lock the alignment body ata location along a length of the first slot defined by the centralsection of the body.

In some embodiments, the alignment body defines a second slot thatinwardly extends from a second end of the alignment body. The first holeand the second slot are configured to receive an elongate surgicalinstrument therein. A second arm can extend from the second end of thecentral section.

In some embodiments, the locking mechanism includes a thumb screw. Insome embodiments, the locking mechanism includes a wing nut.

In some embodiments, the first hole defined by the first arm aligns withthe second slot defined by the alignment body. The alignment body can beconfigured to move along the length of the first slot defined by thebody and to move transversely relative to a longitudinal axis defined bythe first slot.

In some embodiments, the second arm defines a pair of parallel holesadjacent to an end thereof. The first arm can extend perpendicularlyfrom the central section and the second arm can extend from the centralsection at an angle between zero and ninety degrees.

In some embodiments, the first slot extends through a first side and asecond side of the central section. The central section can define asecond slot that extends through a third side and a fourth side of thecentral section of the body. The first hole can extend through the firstarm in a direction that is perpendicular to a longitudinal direction ofthe central section.

In some embodiments, the alignment body defines a second hole thatextends through the alignment body in a first direction and defines athird hole that extends through the alignment body in a seconddirection. The first direction can be parallel to the second direction.

In some embodiments, the alignment body is configured pivot about andaxis that is oriented perpendicularly with respect to a longitudinaldirection of the central section.

In some embodiments, the first arm is configured to rotate about alongitudinal axis defined by the central section of the body and isconfigured to slide in directions that are perpendicular to alongitudinal axis defined by the central section of the body.

In various embodiments is disclosed. The method includes inserting aguide wire into a shaft of a metatarsal without inserting the guide wireinto a head of the metatarsal, coupling an alignment guide to the guidewire, displacing the head of the metatarsal using the alignment guide,inserting a first screw into a first hole defined by the alignmentguide, and inserting a second screw into a second hole defined by thealignment guide. The first hole can define a first axis that is parallelto a second axis defined by the second hole.

In some embodiments, the first and second holes are defined by an armextending from a central section of the alignment guide. The first andsecond holes can be defined by an alignment body that is slidablyreceived within a slot defined by a central section of the alignmentguide.

In various embodiments, a method is disclosed. The method includesinserting a guide wire in a medial-to-lateral direction through a firsthead of a first metatarsal and into a second head of a secondmetatarsal, coupling an alignment guide to the guide wire, inserting afirst screw into a first hole defined by the alignment guide, andinserting a second screw into a second hole defined by the alignmentguide. The first hole can define a first axis that is parallel to asecond axis defined by the second hole.

In some embodiments, the first and second holes are defined by an armextending from a central section of the alignment guide. In someembodiments, the first and second holes are defined by an alignment bodythat is slidably received within a slot defined by a central section ofthe alignment guide.

Although the subject matter has been described in terms of exemplaryembodiments, it is not limited thereto. Rather, the appended claimsshould be construed broadly, to include other variants and embodiments,which may be made by those skilled in the art.

What is claimed is:
 1. An elevator, comprising: a body defining a firstinner cavity sized and configured to receive at least one bone; and adisplacement tip extending from a distal portion of the body, thedisplacement tip having a predetermined radius of curvature, wherein thedisplacement tip is sized and configured to be inserted between a firstbone and a second bone.
 2. The elevator of claim 1, wherein the bodycomprises a closed neck defining a flex point of the body.
 3. Theelevator of claim 2, wherein the body and the closed neck define thefirst inner cavity and a second inner cavity.
 4. The elevator of claim1, wherein the body defines an open proximal end.
 5. A method of formingan osteotomy in a bone; comprising: inserting a burr at a surgical site;positioning a targeting guide adjacent to an outer surface of a surgicalsite, wherein the targeting guide comprises a handle extendingsubstantially along a longitudinal axis, wherein the longitudinal handledefines at least one burr hole extending from a first side of the handleto a second side of the handle, and wherein the targeting guide isslidably coupled to the burr by inserting the burr into the surgicalsite; inserting one or more k-wires into at least one bone at thesurgical site, wherein the one or more k-wires are inserted through aplurality of guide holes formed in a head of the targeting guide; andremoving the targeting guide and the burr from the surgical site.
 6. Themethod of claim 5, comprising cutting a bone at the surgical site,wherein the cut separates the bone into a first bone portion and asecond bone portion.
 7. The method of claim 6, further comprising:inserting an elevator between the first bone portion and the second boneportion at the surgical site, wherein the elevator comprises a bodydefining a first inner cavity sized and configured to receive at leastone bone and a displacement tip extending from a distal portion of thebody, the displacement tip having a predetermined radius of curvature,wherein the displacement tip is sized and configured to be insertedbetween the first bone portion and the second bone portion; and formingan osteotomy between the first bone portion and the second bone portionusing the elevator.
 8. The method of claim 7, wherein the osteotomy is achevron osteotomy.
 9. The method of claim 5, inserting one or morek-wires into the at least one bone comprises inserting a first k-wirethrough a first guide hole in the head and inserting a second k-wirethrough a second guide hole in the head, wherein the first guide hole isdefined by a first tine extending from a base of the head, and whereinthe second guide hole is defined by a second tine extending from thebase of the head.
 10. The method of claim 5, wherein the bone comprisesa metatarsal.
 11. A method of forming an osteotomy in a bone;comprising: inserting a burr at a surgical site; positioning a targetingguide adjacent to an outer surface of a surgical site, wherein thetargeting guide comprises a handle extending substantially along alongitudinal axis, wherein the longitudinal handle defines a firstpositioning hole and a second positioning hole extending from a firstside of the handle to a second side of the handle, and wherein the firstpositioning hole and the second positioning hole each extend through thehandle substantially perpendicular to the longitudinal axis, wherein thefirst positioning hole and the second positioning hole are alignedsubstantially along the longitudinal axis, wherein the first positioninghole and the second positioning hole are parallel to one another; and ahead coupled to a distal end of the longitudinal handle and having adistal surface comprising a stepped surface including a plurality ofoffset surfaces such that each of the plurality of offset surfacesdefines a distal opening of at least one of the plurality of guideholes, wherein the head defines a plurality of guide holes sized andconfigured to receive a k-wire therethrough; inserting one or morek-wires into at least one bone at the surgical site, wherein the one ormore k-wires are inserted through one of the plurality of guide holes;and removing the targeting guide and the burr from the surgical site.12. The method of claim 11, comprising cutting a bone at the surgicalsite, wherein the cut separates the bone into a first bone portion and asecond bone portion.
 13. The method of claim 11, further comprising:inserting an elevator between the first bone portion and the second boneportion at the surgical site, wherein the elevator comprises a bodydefining a first inner cavity sized and configured to receive at leastone bone and a displacement tip extending from a distal portion of thebody, the displacement tip having a predetermined radius of curvature,wherein the displacement tip is sized and configured to be insertedbetween the first bone portion and the second bone portion; and formingan osteotomy between the first bone portion and the second bone portionusing the elevator.
 14. The method of claim 13, wherein the osteotomy isa chevron osteotomy.
 15. The method of claim 11, inserting one or morek-wires into the at least one bone comprises inserting a first k-wirethrough a first guide hole in the head and inserting a second k-wirethrough a second guide hole in the head, wherein the first guide hole isdefined by a first tine extending from a base of the head, and whereinthe second guide hole is defined by a second tine extending from thebase of the head.